Newborn Danger Signs Research Articles

Knowledge and practice of Essential Newborn Care among postnatal mothers in Mekelle City, North Ethiopia: A population-based survey.

BackgroundIn Ethiopia, neonatal mortality remains high and accounts for about half of the under-five mortality. However, there is limited data on the knowledge and practice of mothers about newborn care at the community level, particularly in urban settings. Therefore, this study aimed to assess knowledge and practice of mothers on Essential Newborn Care in urban communities.MethodsA population-based cross-sectional study was conducted in December 2016 in Mekelle City, Northern Ethiopia. A total of 456(weighted) postpartum mothers were included in this study. A three-stage cluster sampling was used to select the study subjects in which districts, Kebeles and respondents formed the first, second and third stage, respectively. Postnatal mothers were recruited from each cluster/Kebele until the required sample size was achieved. They were interviewed using a structured questionnaire. Mothers who responded correctly to at least 75% of the knowledge and practice questions were considered to have good knowledge and practice, respectively. Multivariable logistic regression was used to identify factors associated with the knowledge and practice of Essential Newborn Care.ResultsIn this study, 36.1% of mothers had good knowledge and 81.1% had a good practice on Essential Newborn Care. Newborn care practice was positively associated with those mothers who were educated [Adjusted Odds Ratio (AOR) = 1.94; 95% CI (1.07, 3.50)], counseled during delivery and postpartum [AOR = 4.97; 95% CI (1.93, 12.76)], who had good knowledge of newborn care [AOR = 2.32; 95%CI (1.18, 4.55)] and who had good knowledge of newborn danger signs [AOR = 2.43; 95%CI (1.21, 4.87)].ConclusionsA substantial number of postpartum mothers had poor knowledge and practice on Essential Newborn Care in Mekelle City. Therefore, improving quality and access to maternal health services and home visit using the urban health extension workers at the community level should be encouraged.

Gender Study on Knowledge and Decision Making on Maternal Health Care in Nepal

Background: The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being, without distinction of race, religion, and political belief, economic or social condition.(1). There still exist differences in the factors determining health and the burden of ill-health for women and men. The study is based on addressing the maternal health problems with gender perspectives, and the factors associated with health seeking practices. The main objectives of the study are to find out maternal health problem and gender analysis on decision making (household matters and health care) and the knowledge on danger signs in mother and newborn. Methods:The study is descriptive and cross sectional in design. Household surveys were conducted by the study team in 24 sample VDCs of Baglung, Dolakha and Ramechhap. Results: A total of 959 women were interviewed and 112 (11.40 percent) of them reported having faced emergency obstetric problems and about 5.6 percent of the respondents were found to be suffering from Uterus prolapse problems. The men were found getting more (81.2 percent) opportunities for education than women (58 percent). Women were found to be limited more to household activities that have low economic/monetary value (Women vs. Men: 41.83 percent Vs 4.49 percent) in comparison to men. The women’s status was found to be lower than that of men in all the indicators. The types of occupation were also clearly distinct between men and women in the study districts. Women had better knowledge (50 percent Vs 25 percent) on danger sign in mother and newborn but did not get opportunity of making decision to access health care in time. They were found having to follow their husband’s or in-laws’s decision. Conclusion: Appropriate initiative should be taken for women empowerment in order to develop women autonomy for maternal health care. DOI: http://dx.doi.org/10.3126/hprospect.v11i0.7421 Health Prospect 2012;11:1-6

Prevalence and determinants of essential newborn care practices in the Lawra District of Ghana

BackgroundThere was less than satisfactory progress, especially in sub-Saharan Africa, towards child and maternal mortality targets of Millennium Development Goals (MDGs) 4 and 5. The main aim of this study was to describe the prevalence and determinants of essential new newborn care practices in the Lawra District of Ghana.MethodsA cross-sectional study was carried out in June 2014 on a sample of 422 lactating mothers and their children aged between 1 and 12 months. A systematic random sampling technique was used to select the study participants who attended post-natal clinic in the Lawra district hospital.ResultsOf the 418 newborns, only 36.8% (154) was judged to have had safe cord care, 34.9% (146) optimal thermal care, and 73.7% (308) were considered to have had adequate neonatal feeding. The overall prevalence of adequate new born care comprising good cord care, optimal thermal care and good neonatal feeding practices was only 15.8%.Mothers who attained at least Senior High Secondary School were 20.5 times more likely to provide optimal thermal care [AOR 22.54; 95% CI (2.60–162.12)], compared to women had no formal education at all. Women who received adequate ANC services were 4.0 times (AOR = 4.04 [CI: 1.53, 10.66]) and 1.9 times (AOR = 1.90 [CI: 1.01, 3.61]) more likely to provide safe cord care and good neonatal feeding as compared to their counterparts who did not get adequate ANC. However, adequate ANC services was unrelated to optimal thermal care.Compared to women who delivered at home, women who delivered their index baby in a health facility were 5.6 times more likely of having safe cord care for their babies (AOR = 5.60, Cl: 1.19–23.30), p = 0.03.ConclusionsThe coverage of essential newborn care practices was generally low. Essential newborn care practices were positively associated with high maternal educational attainment, adequate utilization of antenatal care services and high maternal knowledge of newborn danger signs. Therefore, greater improvement in essential newborn care practices could be attained through proven low-cost interventions such as effective ANC services, health and nutrition education that should span from community to health facility levels.

Causal Beliefs Affect Treatment Practices and Preferences for Neonatal Danger Signs in Northwest Ethiopia: A Qualitative Study.

This study was conducted to explore the experiences of community members, particularly mothers, concerning their beliefs about the causes, treatment practices, and preferences for World Health Organization-defined neonatal danger signs in northwest Ethiopia. A phenomenological qualitative study was conducted in three districts of north Gondar Zone, Amhara region, Ethiopia, from March 10 to 28, 2016. Twelve focus group discussions were conducted involving 98 individuals. In-depth interviews were conducted with six health extension workers and 30 women who were either pregnant or who delivered in the past 6 months. Six subthemes emerged explaining the causes of neonatal danger signs. The causes varied from danger sign to danger sign and from person to person. Most of the perceived causes of danger signs in neonates do not align with the current biomedical science. Causal assumptions and perceived seriousness of danger signs influenced treatment practices and preferences. Four subthemes also emerged for treatment practices and preferences. In some cases, respondents indicated that non-biomedical sources of treatment were superior in outcome compared with biomedical treatment options. Unsatisfactory outcomes were mentioned as major reasons to opt for treatments from non-biomedical sources. Religious and cultural reasons were reported to be major impediments for treatment seeking for newborn danger signs. There is an urgent need to introduce or expand locally modified program interventions, such as community-based newborn care, to educate the community on the causes of neonatal danger signs and the need for prompt care seeking from qualified providers.

Knowledge and health-seeking practices of mothers attending primary health-care centers in Baghdad Al-Karkh sector about danger signs in newborns

Background: High-risk neonate defines as one who requires more than the standard monitoring and care offered to a healthy term newborn infant; therefore, early detection of neonatal illness is an important step toward improving newborn survival. Objectives: The objective of this study is to assess the knowledge and health-seeking practices of mothers attending primary health-care centers about WHO recognized danger signs in newborns. Subjects and Methods: A cross-sectional study was carried out in primary health-care centers selected conveniently in Baghdad-Alkarkh district. Participants were 275 mothers of child-bearing age group selected conveniently; the data were collected during the period from March 1 to June 30, 2017. A general questionnaire used for the data collection. Results: About 81% of mothers in study sample listed three or more of the who recognized danger signs. About 71.7% of mothers tend to seek advice or treatment for the illness outside the home. The proportion of good knowledge and health-seeking practices was higher in (Educated, employee, mothers who had a history of antenatal care attendance with higher number of visits). There was no relationship between number of children and family support with seeking care outside the home. Mothers who had good knowledge of danger signs of their babies tend to seek care from health facilities more frequently 75%, and this relation was statistically significant, 61.2% of mothers who perceive illness in newborns delayed seeking advice or treatment outside the home, 66% not taking newborn to the health facilities because they expect self-resolution of the illness. There is good knowledge and perception of mothers toward some danger signs such as fever, poor feeding, and jaundice while fair toward others such as cold body, chest indrawing, and signs of local infections. Conclusion: There are good knowledge and perception of mothers about the WHO recognized danger signs in newborns; however, there is a gap between mothers' knowledge and their health-seeking behavior for sick newborn and explored their deep perceptions, constraints, and various treatments.

Recognition of and care-seeking for maternal and newborn complications in Jayawijaya district, Papua province, Indonesia: a qualitative study

BackgroundIndonesia’s progress on reducing maternal and newborn mortality rates has slowed in recent years, predominantly in rural areas. To reduce maternal and newborn mortality, access to quality and skilled care, particularly at the facility level, is crucial. Yet, accessing such care is often delayed when maternal and newborn complications arise. Using the “Three Delays” model originated by Thaddeus and Maine (1994), investigation into reasons for delaying the decision to seek care, delaying arrival at a health facility, and delaying the receiving of adequate care, may help in establishing more focused interventions to improve maternal and newborn health in this region.MethodsThis qualitative study focused on identifying, analyzing, and describing illness recognition and care-seeking patterns related to maternal and newborn complications in the Jayawijaya district of Papua province, Indonesia. Group interviews were conducted with families and other caregivers from within 15 villages of Jayawijaya who had either experienced a maternal or newborn illness or maternal or newborn death.ResultsFor maternal cases, excessive bleeding after delivery was recognized as a danger sign, and the process to decide to seek care was relatively quick. The decision-making process was mostly dominated by the husband. Most care was started at home by birth attendants, but the majority sought care outside of the home within the public health system. For newborn cases, most of the caregivers could not easily recognize newborn danger signs. Parents acted as the main decision-makers for seeking care. Decisions to seek care from a facility, such as the clinic or hospital, were only made when healthcare workers could not handle the case within the home. All newborn deaths were associated with delays in seeking care due to caretaker limitations in danger sign identification, whereas all maternal deaths were associated with delays in receiving appropriate care at facility level.ConclusionsFor maternal health, emphasis needs to be placed on supply side solutions, and for newborn health, emphasis needs to be placed on demand and supply side solutions, probably including community-based interventions. Contextualized information for the design of programs aimed to affect maternal and newborn health is a prerequisite.

“You have to take action”: changing knowledge and attitudes towards newborn care practices during crisis in South Sudan

Highest rates of neonatal mortality occur in countries that have recently experienced conflict. International Medical Corps implemented a package of newborn interventions in June 2016, based on the Newborn health in humanitarian settings: field guide, targeting community- and facility-based health workers in displaced person camps in South Sudan. We describe health workers’ knowledge and attitudes toward newborn health interventions, before and after receiving clinical training and supplies, and recommend dissemination strategies for improved uptake of newborn guidelines during crises. A mixed methods approach was utilised, including pre–post knowledge tests and in-depth interviews. Study participants were community- and facility-based health workers in two internally displaced person camps located in Juba and Malakal and two refugee camps in Maban from March to October 2016. Mean knowledge scores for newborn care practices and danger signs increased among 72 community health workers (pre-training: 5.8 [SD: 2.3] vs. post-training: 9.6 [SD: 2.1]) and 25 facility-based health workers (pre-training: 14.2 [SD: 2.7] vs. post-training: 17.4 [SD: 2.8]). Knowledge and attitudes toward key essential practices, such as the use of partograph to assess labour progress, early initiation of breastfeeding, skin-to-skin care and weighing the baby, improved among skilled birth attendants. Despite challenges in conflict-affected settings, conducting training has the potential to increase health workers’ knowledge on neonatal health post-training. The humanitarian community should reinforce this knowledge with key actions to shift cultural norms that expand the care provided to women and their newborns in these contexts.

Effect of a participatory multisectoral maternal and newborn intervention on birth preparedness and knowledge of maternal and newborn danger signs among women in Eastern Uganda: a quasi-experiment study

ABSTRACTBackground: Knowledge of obstetric danger signs and adequate birth preparedness (BP) are critical for improving maternal services utilization.Objectives: This study assessed the effect of a participatory multi-sectoral maternal and newborn intervention on BP and knowledge of obstetric danger signs among women in Eastern Uganda.Methods: The Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study was implemented in three districts from 2013 to 2015 using a quasi-experimental pre–post comparison design. Data were collected from women who delivered in the last 12 months. Difference-in-differences (DiD) and generalized linear modelling analysis were used to assess the effect of the intervention on BP practices and knowledge of obstetric danger signs.Results: The overall BP practices increased after the intervention (DiD = 5, p < 0.05). The increase was significant in both intervention and comparison areas (7–39% vs. 7–36%, respectively), with a slightly higher increase in the intervention area. Individual savings, group savings, and identification of a transporter increased in both intervention and comparison area (7–69% vs. 10–64%, 0–11% vs. 0–5%, and 9–14% vs. 9–13%, respectively). The intervention significantly increased the knowledge of at least three obstetric danger signs (DiD = 31%) and knowledge of at least two newborn danger signs (DiD = 21%). Having knowledge of at least three BP components and attending community dialogue meetings increased the odds of BP practices and obstetric danger signs’ knowledge, respectively. Village health teams’ home visits, intervention area residence, and being in the 25+ age group increased the odds of both BP practices and obstetric danger signs’ knowledge.Conclusions: The intervention resulted in a modest increase in BP practices and knowledge of obstetric danger signs. Multiple strategies targeting women, in particular the adolescent group, are needed to promote behavior change for improved BP and knowledge of obstetric danger signs.

Working with community health workers to improve maternal and newborn health outcomes: implementation and scale-up lessons from eastern Uganda

ABSTRACTBackground: Preventable maternal and newborn deaths can be averted through simple evidence-based interventions, such as the use of community health workers (CHWs), also known in Uganda as village health teams. However, the CHW strategy faces implementation challenges regarding training packages, supervision, and motivation.Objectives: This paper explores knowledge levels of CHWs, describes the coverage of home visits, and shares lessons learnt from setting up and implementing the CHW strategy.Methods: The CHWs were trained to conduct four home visits: two during pregnancy and two after delivery. The aim of the visits was to promote birth preparedness and utilization of maternal and newborn health (MNH) services. Mixed methods of data collection were employed. Quantitative data were analyzed using Stata version 13.0 to determine the level and predictors of CHW knowledge of MNH. Qualitative data from 10 key informants and 15 CHW interviews were thematically analyzed to assess the implementation experiences.Results: CHWs’ knowledge of MNH improved from 41.3% to 77.4% after training, and to 79.9% 1 year post-training. However, knowledge of newborn danger signs declined from 85.5% after training to 58.9% 1 year later. The main predictors of CHW knowledge were age (≥ 35 years) and post-primary level of education. The level of coverage of at least one CHW visit to pregnant and newly delivered mothers was 57.3%. Notably, CHW reports complemented the facility-based health information. CHWs formed associations, which improved teamwork, reporting, and general performance, and thus maintained low dropout rates at 3.6%. Challenges included dissatisfaction with the quarterly transport refund of 6 USD and lack of means of transportation such as bicycles.Conclusions: CHWs are an important resource in community-based health information and improving demand for MNH services. However, the CHW training and supervision models require strengthening for improved performance. Local solutions regarding CHW motivation are necessary for sustainability.

Effect on Neonatal Mortality of Newborn Infection Management at Health Posts When Referral Is Not Possible: A Cluster-Randomized Trial in Rural Ethiopia.

The World Health Organization recently provided guidelines for outpatient treatment of possible severe bacterial infections (PSBI) in young infants, when referral to hospital is not feasible. This study evaluated newborn infection treatment at the most peripheral level of the health system in rural Ethiopia. We performed a cluster-randomized trial in 22 geographical clusters (11 allocated to intervention, 11 to control). In both arms, volunteers and government-employed Health Extension Workers (HEWs) conducted home visits to pregnant and newly delivered mothers; assessed newborns; and counseled caregivers on prevention of newborn illness, danger signs, and care seeking. Volunteers referred sick newborns to health posts for further assessment; HEWs referred newborns with PSBI signs to health centers. In the intervention arm only, between July 2011 and June 2013, HEWs treated newborns with PSBI with intramuscular gentamicin and oral amoxicillin for 7 days at health posts when referral to health centers was not possible or acceptable to caregivers. Intervention communities were informed of treatment availability at health posts to encourage care seeking. Masking was not feasible. The primary outcome was all-cause mortality of newborns 2-27 days after birth, measured by household survey data. Baseline data were collected between June 2008 and May 2009; endline data, between February 2013 and June 2013. We sought to detect a 33% mortality reduction. Analysis was by intention to treat. (ClinicalTrials.gov registry: NCT00743691). Of 1,011 sick newborns presenting at intervention health posts, 576 (57%) were identified by HEWs as having at least 1 PSBI sign; 90% refused referral and were treated at the health post, with at least 79% completing the antibiotic regimen. Estimated treatment coverage at health posts was in the region of 50%. Post-day 1 neonatal mortality declined more in the intervention arm (17.9 deaths per 1,000 live births at baseline vs. 9.4 per 1,000 at endline) than the comparison arm (14.4 per 1,000 vs. 11.2 per 1,000, respectively). After adjusting for baseline mortality and region, the estimated post-day 1 mortality risk ratio was 0.83, but the result was not statistically significant (95% confidence interval, 0.55 to 1.24; P=.33). When referral to higher levels of care is not possible, HEWs can deliver outpatient antibiotic treatment of newborns with PSBI, but estimated treatment coverage in a rural Ethiopian setting was only around 50%. While our data suggest a mortality reduction consistent with that which might be expected at this level of coverage, they do not provide conclusive results.

FACTORS RELATED TO KNOWLEDGE ON NEWBORN DANGER SIGNS AMONG THE RECENTLY DELIVERED WOMEN IN SUB-DISTRICT HOSPITALS OF BANGLADESH

Background: Bangladesh continues to be one of the top ten countries with the highest burden of neonatal mortality. While, most of the neonatal deaths are preventable; health system delays, delayed identification of newborn danger signs, late diagnosis and initiation of treatment are claimed to be the main challenges.Objective: 1) to determine the level of knowledge among the recently delivered women (RDW) about newborn danger signs and 2) to distinguish the factors associated with ability of identifying the danger signs.Methods: A facility based cross-sectional study was conducted in three sub-district hospitals of Bangladesh among 135 RDW between 1 January 2015 and 30 April 2015. Seven key danger signs were identified, and responses were categorized accordingly. Bivariable logistic regression was conducted to determine the likelihood of the association of factors with danger signs identification.Results: About 51% of RDW could identify one key danger sign. Knowledge on “fever’’ was the most commonly known danger sign (65%). Middle age (OR 1.67, 95% CI: 1.09 - 2.18), high education (OR 2.37, 95% CI: 1.46 - 2.77), increased parity (OR 1.91, 95% CI: 1.17 - 2.89), and previous hospital delivery (OR 1.79, 95% CI: 1.14 - 2.68) were found associated with the knowl­edge of the danger signs.Conclusion: The findings indicate the immediate need to enhance health education among the RDW about newborn danger signs before their hospital discharge. Community based health education programs can be a cost effective intervention to increase awareness and early recognition of neonatal danger signs.

The effect of social behavior change communication package on maternal knowledge in obstetric danger signs among mothers in East Mamprusi District of Ghana

BackgroundAn understanding of maternal knowledge of the danger signs of obstetric and newborn complications is fundamental to attaining universal health coverage. In Northern Ghana, where maternal and newborn morbidity and mortality is high, little is known about the current knowledge level and associated determinants of these danger signs. This study assessed the effect of social behavior change communication (SBCC) package on knowledge of obstetric and newborn danger signs among mothers with children under 24 months of age.MethodsThis study used a non-randomized controlled community-based intervention design with pre and post-intervention household surveys in the intervention and comparison communities of the East Mamprusi District in Ghana. The study population were selected using a two-stage cluster sampling procedure.ResultOnly 521 (51.1%), 300 (29.4%) and 353 (34.6%) of the study participants knew at least three key danger signs during pregnancy, delivery and postpartum period respectively.The intervention had a positive effect on maternal knowledge of danger signs. Compared to their counterparts in the comparison communities, women in the intervention communities were about 2.6 times (AOR = 2. 58 [CI: 1.87, 3.57]), 3.4 times (AOR = 3.39 [CI: 2.31, 4.96]) and 2.2 times (AOR = 2.19 [CI: 1.68, 2.84]) more likely to have higher knowledge of danger signs of childbirth, postpartum and neonate, respectively.Having sought postnatal services at least once was significantly associated with the mentioning of at least three danger signs of postpartum (AOR = 3.90 [CI: 2.01, 7.58]) and childbirth (AOR = 1.75 [CI: 1.06, 2.85]).ConclusionThere was a significant contribution of social and behavioral change communication as an intervention to maternal knowledge in obstetric danger signs after adjusting for confounding factors such as antenatal and post-natal care attendance. Therefore, provision of information, education and communication targeting women on danger signs of pregnancy and childbirth and associated factors would be an important step towards attaining universal health coverage.

KNOWLEDGE OF GOVERNMENT AND PRIVATE PRIMARY HEALTH CARE WORKERS ON NEWBORN CARE COMPONENTS: A QUESTIONNAIRE-BASED CROSS-SECTIONAL COMPARATIVE STUDY

ABSTRACTObjective: This study was done to evaluate the knowledge of primary health-care workers about the newborn care components.Methods: The Institutional Ethics Committee approval was obtained, and a cross-sectional study was carried out among the primary health-careworkers of Karaikal using a pretested questionnaire from January 2015 to March 2015. The questionnaire contained questions on various domains ofnewborn care components. The study participants were explained about the study. Verbal informed consent was obtained, and the questionnaire wasintroduced to 383 health-care workers. The answered questionnaires were collected and analyzed.Results: A total of 349 participants (192-government employees; 157-private employees) were willing to take part in the study. Most (54.7%) of thegovernment participants were nurses and auxiliary nurse midwives (43.2%) whereas the private sector participants were predominantly (79%)nurses. The knowledge level about some of the newborn care components, namely, positioning and attachment, advice on discharge, time of follow-upcheckup, bad child rearing practices, and danger signs of newborn were assessed to be predominantly inadequate among a majority of health workersof both sectors. 22.29% and 41.1% of the private health-care workers and government health-care workers respectively, were having an overalladequate knowledge (overall score &gt;75%) on newborn care components. Knowledge of the government health workers was significantly better thanprivate health-care staff (P &lt; 0.001).Conclusion: Knowledge is found to be inadequate among health-care workers on some newborn care components which necessitate measures toimprove.Keywords: Newborn care, Nurses, Midwives, Inadequate knowledge, Training programs.

A mixed methods assessment of barriers to maternal, newborn and child health in Gogrial West, South Sudan

BackgroundHealth conditions for mothers, newborns, and children in South Sudan are among the worst worldwide. South Sudan has the highest rate of maternal mortality in the world and despite alarming statistics, few women and children in South Sudan have access to needed healthcare, especially in rural areas. The purpose of this study was to understand the barriers to maternal, newborn and child health in Gogrial West, Warrap State, South Sudan, one of the most underdeveloped states.MethodsA randomized household quantitative study and supplemental qualitative interviews were employed in 8/9 payams in Gogrial West, Warrap, South Sudan. Interviews were conducted with randomly selected female household members (n = 860) who were pregnant or had children less than 5 years of age, and men (n = 144) with a wife having these characteristics. Non-randomized qualitative interviews (n = 72) were used to nuance and add important socio-cultural context to the quantitative data. Analysis involved the estimation of weighted population means and percentages, using 95% confidence intervals and considering p-values as significant when less than 0.05, when comparisons by age, age of marriage, wife status and wealth were to be established.ResultsMost women (90.8%) and men (96.6%) did not want contraception. Only 1.2% of women aged 15–49 had met their need for family planning. On average, pregnant women presented for antenatal care (ANC) 2.3 times and by unskilled providers. Less than half of households had a mosquito net; fewer had insecticide treated nets. Recognition of maternal, newborn and child health danger signs overall was low. Only 4.6% of women had skilled birth attendants. One quarter of children had verifiable DPT3 immunization. Five percent of men and 6% of women reported forced intercourse. Overall men and women accept beatings as a norm.ConclusionBarriers to care for mothers, infants and children are far more than the lack of antenatal care. Maternal, newborn and child health suffers from lack of skilled providers, resources, distance to clinics. A lack of gender equity and accepted negative social norms impedes healthy behaviors among women and children. The paucity of a peer-reviewed evidence base in the world’s newest country to address the overwhelming needs of the population suggests these data will help to align health priorities to guide programmatic strategy for key stakeholders.

Awareness and Associated Factors towards Neonatal Danger Signs among Mothers Attending Public Health Institutions of Mekelle City, Tigray, Ethiopia, 2015

Background: Neonatal mortality and morbidity are the greatest challenges in the current health care scenario. Majority of newborns die because mothers fail to identify danger signs of illness, and inappropriate/delayed care seeking. The most common identified newborn danger signs are fever, lethargy, inability to feed, low temperature, fast breathing, persistent vomiting, convulsions, pus draining/bleeding from umbilical area, lack of consciousness, yellow palm/sole/eye and eye discharge/redness. Objective was to assess the awareness level and factors associated towards neonatal danger sign among mothers who attend public health institutions of Mekelle City, Tigray, Ethiopia, 2015.Method: A cross sectional study design was conducted from December 2014 to June 2015 among mothers who attend public health institutions of Mekelle city, Simple random sampling technique was used to select the study participants. The data were collected using interviewer administered structured questionnaire. Pre-test was done on 5% of the sample two weeks before the actual data collection period at Qui ha health center based on the result of the pre-test necessary corrections were made to the questionnaire. After the data was collected it was entered, cleaned and analyzed using SPSS version 20 statistical software. Descriptive statistics were employed. Binary logistic regression was used to see the association between the dependent and various independent variables. Finally, data are presented using text, tables and graphs.Result: This study found that half (50.6%) of mothers had an awareness of at least three neonatal danger signs. Fever, persistent vomiting and poor sucking was the three most commonly reported neonatal danger signs. To the reverse, umbilical redness, eye discharge, yellow palms/soles/eyes were found to be the least known neonatal danger signs which was reported by less than 5% of the study subjects. Birth preparedness by, at least in two ways [AOR=2.5; 95% CI (1.35, 4.66)] and post-natal care and advice [AOR=3.4; 95% CI (2.01, 5.77)] were the independent variables that show significant association with awareness of mothers toward neonatal danger signs in this study.Conclusion and recommendations: Majority of mothers had low awareness of the majority of neonatal danger signs. Strengthening educational programs at a health facility or community level is highly recommended.

Knowledge, attitude and practices on the care of the newborn in postnatal mothers delivering at a tertiary care centre in Nepal

Introduction: Neonatal mortality rate per thousand live births in Nepal is 24.2, and the majority of neonates die during the early neonatal period. Objective: To determine the knowledge, attitudes and practices of mothers regarding care of the newborn after delivery at a tertiary teaching hospital in Nepal. Method: A cross-sectional study employing both quantitative and qualitative study approaches was conducted in the Maternal and Child Health (MCH) unit of a tertiary hospital in East Nepal for a period of three months. Using a convenient sampling technique 65 postpartum mothers admitted in MCH unit were enrolled in the study. Structured interview questionnaires were used to collect data. Data was analyzed using descriptive statistics by SPSS 20. Results: Sixty five mothers who delivered at the tertiary care centre were interviewed. Age of mothers ranged from 16 to 40 years, 63% were primipara and 18.4% were illiterate. Whilst 95% of mothers knew about immunisation, few had acquired knowledge regarding cord care, signs of illness in newborn and newborn feeding during antenatal checkups. Maternal knowledge about newborn danger signs was low. Breast feeding practice as observed by interviewer was not satisfactory. Maternal knowledge on newborn hygiene care was unsatisfactory. Conclusion: Maternal knowledge, attitudes and practices regarding care of the newborn after delivery at the tertiary teaching hospital in Nepal requires improvement.

The neonatal mortality and its determinants in rural communities of Eastern Uganda.

BackgroundIn Uganda, neonatal mortality rate (NMR) remains high at 27 deaths per 1000 live births. There is paucity of data on factors associated with NMR in rural communities in Uganda. The objective of this study was to determine NMR as well as factors associated with neonatal mortality in the rural communities of three districts from eastern Uganda.MethodsData from a baseline survey of a maternal and newborn intervention in the districts of Pallisa, Kibuku and Kamuli, Eastern Uganda was analyzed. A total of 2237 women who had delivered in the last 12 months irrespective of birth outcome were interviewed in the survey. The primary outcome for this paper was neonatal mortality. The risk ratio (RR) was used to determine the factors associated with neonatal mortality using log - binomial model.ResultsThe neonatal mortality was found to be 34 per 1000 live births (95 % CI = 27.1–42.8); Kamuli 31.9, Pallisa 36.5 and Kibuku 30.8. Factors associated with increased neonatal deaths were parity of 5+ (adj. RR =2.53, 95 % CI =1.14–5.65) relative to parity of 4 and below, newborn low birth weight (adj. RR = 3.10, 95 % CI = 1.47–6.56) and presence of newborn danger signs (adj. RR = 2.42, 95 % CI = 1.04–5.62). Factors associated with lower risk of neonatal death were, home visits by community health workers’ (CHW) (adj. RR =0.13, 95 % CI = 0.02–0.91), and attendance of at least 4 antenatal visits (adj. RR = 0.65, 95 % CI = 0.43–0.98).ConclusionsNeonatal mortality in rural communities is higher than the national average. The use of CHW’s to mobilize and sensitize households on appropriate maternal and newborn care practices could play a key role in reducing neonatal mortality.

A study to Assess The Effectiveness of Structured Teaching Program on Knowledge Regarding Newborn Care and Danger Signs of New Born among The Postnatal Mothers in Kirumambakkam PHC, Puducherry.

A study to Assess The Effectiveness of Structured Teaching Program on Knowledge Regarding Newborn Care and Danger Signs of New Born among The Postnatal Mothers in Kirumambakkam PHC, Puducherry.

Newborn care in Urban slums: A missed opportunity

Introduction: Neonatal mortality and morbidity are the greatest challenges in the current health care scenario. Majority of neonates die because mothers fail to identify danger signs of illness, and inappropriate or delayed care seeking. Objective was to find out the awareness among mothers regarding newborn care, essential newborn care practices and health care seeking behaviour in Urban slums. Methodology: A cross sectional study was done among the study population of Urban slums, Bhangel, Noida which is the field practice area of Urban Health Training Centre, Department of Community Medicine, SMS&R, Greater Noida. Duration of the study was from 1st March to 31st August 2014. All mothers with infants less than 3months of age approaching the Urban Health Training Centre, Bhangel were taken as study subjects. Prevalidated semi structured questionnaire was used for interviewing mothers. Informed consent was taken from them about the participation in this study. Data was analysed using SPSS 17.0 version. Result and conclusion: Most of the mothers lacked awareness regarding newborn danger signs and essential newborn care practices. The common reasons behind harmful practices were lack of awareness, traditional and cultural taboos and lack of free time for those mothers who were working.

Determinants of early initiation of breastfeeding in rural Tanzania.

BackgroundBreastfeeding is widely known for its imperative contribution in improving maternal and newborn health outcomes. However, evidence regarding timing of initiation of breastfeeding is limited in Tanzania. This study examines the extent of and factors associated with early initiation of breastfeeding in three rural districts of Tanzania.MethodsData were collected in 2011 in a cross–sectional survey of random households in Rufiji, Kilombero and Ulanga districts of Tanzania. From the survey, 889 women who had given birth within 2 years preceding the survey were analyzed. Both descriptive and inferential statistical analyses were conducted. Associations between the outcome variable and each of the independent variables were tested using chi–square. Logistic regression was used for multivariate analysis.ResultsEarly initiation of breastfeeding (i.e. breastfeeding initiation within 1 h of birth) stood at 51 %. The odds of early initiation of breastfeeding was significantly 78 % lower following childbirth by caesarean section than vaginal birth (adjusted odds ratio (OR) = 0.22; 95 % confidence interval (CI) 0.14, 0.36). However, this was almost twice as high for women who gave birth in health facilities as for those who gave birth at home (OR = 1.75; 95 % CI 1.25, 2.45). Furthermore, maternal knowledge of newborn danger signs was negatively associated with early initiation of breastfeeding (moderate vs. high: OR = 1.73; 95 % CI 1.23, 2.42; low vs. high: OR = 2.06; 95 % CI 1.43, 2.96). The study found also that early initiation of breastfeeding was less likely in Rufiji compared to Kilombero (OR = 0.52; 95 % CI 0.31, 0.89), as well as among ever married than currently married women (OR = 0.46; 95 % CI 0.25, 0.87).ConclusionsTo enhance early initiation of breastfeeding, using health facilities for childbirth must be emphasized and facilitated among women in rural Tanzania. Further, interventions to promote and enforce early initiation of breastfeeding should be devised especially for caesarean births. Women residing in rural locations and women who are not currently married should be specifically targeted with interventions aimed at enhancing early initiation of breastfeeding to ensure healthy outcomes for newborns.